Active NPI
Angel Marie Vance, P.T.A
- Physical Therapy Assistant
- Detroit, MI
National Provider Identifier
1215139050
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 04870
- Practice address
- 1331 Trumbull St Ste 100
Detroit, MI 48216-1376 - Phone
- (313) 962-9050
- NPI assigned
- Jun 4, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 04870 | OH | Primary |
Addresses
Primary practice location
1331 Trumbull St Ste 100
Detroit, MI 48216-1376
Mailing address
19977 Hudson Bay
Clinton TWP, MI 48038-1493
Phone (586) 416-1990
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 04870 | Other | OH | OHIO PHYSICAL THERAPY |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 04870 | OH | MD | Physical Therapy Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1180915200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1215139050",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "19977 HUDSON BAY",
"city": "CLINTON TWP",
"state": "MI",
"postal_code": "480381493",
"telephone_number": "586-416-1990"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1331 TRUMBULL ST STE 100",
"city": "DETROIT",
"state": "MI",
"postal_code": "482161376",
"telephone_number": "313-962-9050"
}
],
"practiceLocations": [],
"basic": {
"last_name": "VANCE",
"first_name": "ANGEL",
"middle_name": "MARIE",
"credential": "P.T.A",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-06-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": "OH",
"license": "04870",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "OHIO PHYSICAL THERAPY",
"identifier": "04870",
"state": "OH"
}
],
"endpoints": [],
"other_names": []
}Other providers in Detroit, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.